CMS Price Transparency Data

Upper endoscopy with biopsy

Facility: Watsonville Community Hospital

Billing Code: 43239 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 43239
Insurance Median: $336
Cash Discount Price: $2,393
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a Upper endoscopy with biopsy at Watsonville Community Hospital is $336. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,393. Compared to the federal Medicare reimbursement reference rate of $926.63, this hospital’s rate is 0.36x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.

Cash / Self-Pay

$2,393

Average discount available for prompt cash payment at this facility.

Insurance Median

$336

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$926.63

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $926.63 (100%)

Cash / Self-Pay: $2,393 (258%)

Insurance Median: $336 (36%)

Cash: $2,393 (258% of Medicare)

Ins. Median: $336 (36% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $926.63 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
California Childrens Srvs	$295 - $336	32%
Ccs/Monterey County	$295 - $336	32%
Healthy Families	$295 - $336	32%
Medi-Cal E.R.	$295 - $336	32%
Medi-Cal/Eds	$295 - $336	32%
Medicaid / KanCare	$295 - $336	32%
Well Path	$295 - $336	32%
Alliance/Sccho	$433 - $576	47%
Aetna	$504 - $4,963	54%
Blue Cross Blue Shield	$504 - $6,374	54%
Blue Shield Hmo	$504	54%
Cigna	$504	54%
Great-West/Phcs	$504	54%
Health Net Pmg Hmo	$504	54%
Pacificare Hmo	$504	54%
Secure Horizons Dign Hmo	$504	54%
UnitedHealthcare	$504	54%
Calif Ironworkers Field	$6,374	688%
Carpenters H&W Trust	$6,374	688%
City Of Wats/Pinnacle Clm	$6,374	688%
Claims Management Wc	$6,374	688%
Delta Health Systems	$6,374	688%
Laborers Health & Welfare	$6,374	688%
Monterey Bay Pub Emp Trst	$6,374	688%
Operating Engineers	$6,374	688%
Pinnacle Claims Tpa/Bc	$6,374	688%
Robert Kennedy/Ccn	$6,374	688%
Sheet Metal Workers	$6,374	688%
State Compensation Fund	$6,374	688%
Teamsters Benefit Trust	$6,374	688%
Western Growers Trust/Bc	$6,374	688%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $2,393.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 43239.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Watsonville Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 43239.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.